Decision making process in simultaneous laparoscopic resection of colorectal cancer and liver metastases. Review of literature

• Main Author: Araujo,Raphael Leonardo Cunha de
• Publication Date: 2020
• Other Authors: Figueiredo,Marleny Novaes, Sanctis,Marco Aurélio de, Romagnolo,Luís Gustavo Capochin, Linhares,Marcelo Moura, Melani,Armando Geraldo Franchini, Marescaux,Jacques
• Format: Article
• Language: eng
• Source: Acta Cirúrgica Brasileira (Online)
• Download full: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502020000300500
• topic: Colorectal Neoplasms; Neoplasms, Multiple Primary; Laparoscopy; Hepatectomy; Colectomy

Abstract Purpose: The benefits of laparoscopic approaches to treat colorectal cancer (CRC) and colorectal liver metastases (CRLM) separately are well established. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged. The objective of this review with practical reports is to discuss technical aspects required for patient selection to perform simultaneous laparoscopic approaches for CRC and CRLM. Methods: Literature review of oncological factors associated with patient selection for surgical treatment of CRLM and the use of laparoscopy in those cases, and report of technical aspects for simultaneous CRC and CRLM approaches. Results: Simultaneous laparoscopic resection has been successful in many series of selected patients, although it seems to be safer to perform minor and major liver resection with non-extended colorectal resections, and to avoid two high-risk procedures at the same time. Conclusions: Simultaneous CRC and CRLM resections seem to be safe when patients are carefully selected, also considering the risk of recurrence concerning oncologic outcomes. The pre-planning of simultaneous resection is mandatory to plan trocar positioning, procedure sequencing, and patient position.